Existing diabetes quality measures in the U.S. do not adequately improve the quality of care or outcomes, according to new research published in Health Affairs.
The burden of diabetes falls disproportionately on minorities and rural residents. Yet the types of quality measures and their volume currently being used “contribute to missed opportunities to align quality measurement with the pursuit of high-quality diabetes care and optimal health outcomes,” the study authors wrote. According to Centers for Disease Control and Prevention data, hard diabetes-related outcomes have not meaningfully improved since 2015, per the study.
Insurance coverage is another “strong predictor” of diabetes care quality, the study said. Being uninsured or having high out-of-pocket expenses under high-deductible health plans is associated with higher rates of diabetes, undiagnosed diabetes, complications or forgoing care.
There are several pitfalls among two commonly used metrics from the National Committee for Quality Assurance and MN Community Measurement. One is they don’t protect against inappropriate treatment and do not correlate perfectly with hard outcomes. They are also threshold measures, and thus don’t reflect clinical decisions that may substantially lower the risk of diabetes complications even if a patient doesn’t meet a threshold.
The unintended result, the study’s authors wrote, is a perverse incentive for providers to focus on patients most likely to achieve a threshold than those who might benefit the most. People of lower socioeconomic status, for instance, are more likely to have multiple unmet measures that worsen inequity and are at higher risk.
Existing measures are often contradictory and result in administrative burdens that keeps clinicians away from patients. There are also no measures of equity, efficiency or value, timeliness or patient-centeredness of care, the study said. Yet improving upon inequities found in social determinants of health is “an urgent national priority.” The study suggested using the strategies of federally qualified health centers and other safety net providers to collect and report on social determinants of health.
To be effective incentives, quality measures should be tied to reimbursement and support evidence-based care, prioritize high-risk patients, encourage cross-sector collaboration and reduce administrative burdens on clinicians, the study said.
To improve the quality of diabetes care, the authors suggested widespread adoption of new measures and modernization of existing measures as well as the use of new metrics as top-line measures for reporting and reimbursement.